PURPOSE: The C-14 urea breath test (C-14 UBT) is the most specific noninvasive method to detect Helicobacter (H) pylori infection. We investigated if the C-14 UBT can reflect the presence and degree of H. pylori detected by gastroduodenoscopic biopsies (GBx). MATERIALS AND METHODS: One hundred fifty patients (M:F=83:67, age 48.6+/-11.2 yrs) underwent C-14 UBT, rapid urease test (CLO test) and GBx on the same day. For the C-14 UBT, a single breath sample was collected at 10 minutes after ingestion of C-14 urea (137 KBq) capsule and counting was done in a liquid scintillation counter for 1 minute, and the results were classified as positive ( 200 dpm), intermediate (50~199 dpm) or negative (<50 dpm). The results of CLO tests were classified as positive or negative according to color change. The results of GBx on giemsa stain were graded 0 (normal) to 4 (diffuse) according to the distribution of H. pylori by the Wyatt method. We compared C-14 UBT results with GBx grade as a gold standard. RESULTS: In the assessment of the presence of H. pylori infection, the C-14 UBT global performance yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 92.5%, 88.4%, 97.1%, 88.4% and 91.3%, respectively. However, the CLO test had sensitivity, specificity, PPV, NPV and accuracy of 83.2%, 81.4%, 91.8%, 81.4% and 82.7%, respectively. The quantitative values of the C-14 UBT were 45+/-27 dpm in grade 0, 707+/-584 dpm in grade 1, 1558+/-584 dpm in grade 2, 1851+/-604 dpm in grade 3, and 2719+/-892 dpm in grade 4. A significant correlation (r=0.848, p<0.01) was found between C-14 UBT and the grade of distribution of H. pylori infection on GBx with giemsa stain. CONCLUSION: We conclude that the C-14 UBT is a highly accurate, simple and noninvasive method for the diagnosis of ongoing H. pylori infection and reflects the degree of bacterial distribution.
Azure Stains ; Biopsy ; Breath Tests* ; Diagnosis ; Eating ; Helicobacter pylori* ; Helicobacter* ; Humans ; Scintillation Counting ; Sensitivity and Specificity ; Urea* ; Urease

The thirty eight newborn infants with periventricular leukomalacia who were admitted to the neonatal intensive care unit of Gil General Hospital from March 1, 1988 to June 30, 1991, were investigated for ultrasonographic findings, risk factors and neurological outcome. The results were as follows: 1) There were 38 cases of PVL including 21 echogenic flarings and 17 cystic PVL's. 2) Mean birth weight was 2,250 gm and mean gestational age was 35 week. 3) Mean detection timing was 4th day in echogenic flarings and 18th day in cystic PVL's. 4) PVL's were located in the parietal region in 1 case and fronto-parieto-occipital in 3 cases. 5) Mean cyst size was 6 mm. 6) Multiple logistic regression analysis for the risk factors of PVL showed that low birth weight, apnea and seizure were the most significant contributing factors (p<0.05). 7) In the follow-up study of cystic PVL's, 7 cases showed improvement, 7 cases developed into multicystic encephalomalacia and 3 cases developed into atrophy. 8) Neurodevelopmental outcome of cystic PVL's showed nomal; 6.2%, minor neurodevelopmental defect; 43.8%, major neurodevelopmental defect; 31.2% and death; 18.8%. 9) Neurosonographic predictability for neurodevelopemental sequelae by cystic PVL's showed sensitivity; 63.6%%, specificity; 98.0%, positive predictive value; 92.8% and accuracy; 88.2%. 10) Major neurodevelopmental defect was more frequent, cyst size being larger and location being more extensive (p<0.05).
Apnea ; Atrophy ; Birth Weight ; Encephalomalacia ; Follow-Up Studies ; Gestational Age ; Hospitals, General ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular* ; Logistic Models ; Rabeprazole ; Risk Factors* ; Seizures ; Sensitivity and Specificity

BACKGROUND: Among the various physiochemical stimuli, hypoxia has been known to cause coronary vasodilation. In contrast to this, endothelial dependent contracting factor(EDCF) was shown to be secreted by hypoxia and overall physiological roles of these apparently contradicting two phenomena are not clear. Although coronary vasodilation is dominant in epicardial coronary artery by hypoxia, collateral circulation may show different response from epicardial coronary artery to the same stimulus and effect of hypoxia on the vasomotor tone of collateral vessels has not been established. METHODS: Left circumflex coronary artery was chronically occluded using Ameriod occluder in the canine model and myocardial blood flow through collateral circulation was measured using microsphere during induced regional hypoxia. RESULTS: 1) Myocardial blood flow measurements during oxygenated and hypoxic solution infusion were 1.11+/-0.11 mg/min/g and 1.12+/-0.10 ml/min/g respectively in normal perfused zone(LAD territory), but in the collateral dependent zone(LCX territory) blood flow decreased significantly during hypoxic solution infusion(0.55+/-0.17 ml/min/g vs 0.43+/-0.21 ml/min/g)(p<0.05). Also myocardial blood flow ratio(LCX/LAD territory) decreased significantly during hypoxic solution infusion(0.49+/-0.16 vs 0.39+/-0.02)(p<0.05). 2) In collateral dependent zone, endocardial and epicardial blood flow ratio showed significant redistribution during hypoxic solution infusion. 3) After verapamil administration, myocardial blood flow in collateral dependent zone increased from 0.43+/-0.21ml/mg/g to 0.56+/-0.23 ml/mg/g(p<0.05). Also myocardial blood flow ratio(LCX/LAD territory) increased from 0.39+/-0.20 to 0.50+/-0.20 to 0.50+/-0.21 after verapamil administration. CONCLUSION: Hypoxia seems to cause vasoconstriction in collateral vessels and redistribution of blood flow in collateral dependent zone and these effects can be reversed by verapamil.
Anoxia* ; Collateral Circulation* ; Coronary Vessels ; Microspheres ; Oxygen ; Vasoconstriction ; Vasodilation ; Verapamil

BACKGROUND: Isolated coronary ostial stenosis presumed to be atherosclerosis in origin is a rare condition reported to have peculiar characteristics-that occurs primarily in premenopausal women, low incidence of risk factors, severe symptoms of short duration with absence of collaterals suggesting rapid development. METHODS: From Feb. 1979 to May. 1991, 11 patients with isolated left coronary ostial stenosis were identified among 2520 coronary angiographies and they were presumed to be athreosclerosis in origin by excluding other alleged causes. RESULTS: There were 5 males and 6 females with mean ages of 47.8+/-9.5 and 51.5+/-7.9 respectively. Clinical presentations were stable angina in 4, unstable angina in 6 patients, and unstable angina after myocardial infarction in 1 patient.Number of risk factors per patient was 0.82+/-0.98. Majority showed a relatively short history of angina(mean 3.6+/-2.8 months). Coronary angiographic findings showed collateral circulation in 7 patients-grade III in 5 of them. There was 1 death related to coronary angiography. Coronary artery bypass surgeries were performed in 7 patients and 5 of them were followed for mean 22+/-8 months without coronary events. CONCLUSIONS: In contrast to the previous reports, isolated left coronary ostial stenosis presumed to be atherosclerosis in orign did not showed female predelication and although their symptom durations were relatively short coronary angiographies showed well developed collaterals in the majority of patients.We experienced one coronary angiography related death in this group of patients. Coronary artery bypass surgery is to be recommended in these patients otherwise contraindicated.
Angina, Stable ; Angina, Unstable ; Atherosclerosis* ; Collateral Circulation ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Bypass ; Female ; Humans ; Incidence ; Male ; Myocardial Infarction ; Risk Factors

BACKGROUND AND OBJECTIVES: There has been a need for functional status measurement tool with better validity than the existing tools such as New York Heart Association Functional Class. Duke Activity Status Index (DASI) is a representative example of a tool that was developed to enhance the validity of measurement by asking the patients about the ability to perform specific activities and scoring the response. Because such a tool must be culture-sensitive, it is desirable to use 'Koreanized' version of the tool. No Koreanized version of the functional status measurement tool has been developed yet. The objective of this study is to develop a Korean version of DASI. MATERIALS AND METHOD: In the developmental phase, a pilot questionnaire asking the ability to perform specific activity was made with reference to existing tools, such as Specific Activity Scale and DASI. Substitution, correction and addition of items were done through the pilot study. Ninety-nine patients was asked to fill developmental version of questionnaire, then underwent treadmill exercise test. Weight for each items were assigned to optimize the correlation between the calculated index (KASI) and total treadmill exercise time. Criteria for categorical functional classification were determined to maximize the agreement between KASI-estimated functional class (KASIFC) and functional class estimated by exercise time. In the validation phase, final version of questionnaire was tested in independent group of 159 patients. The questionnaire was self-administered. Canadian Cardiovascular Society Functional Class (CCSFC) was estimated by the physician who is in charge of treadmill exercise test. RESULTS: In the validation phase, Spearman correlation coefficient between KASI and treadmill exercise time was 0.62(p=.0001) and between CCSFC and exercise time -0.48(p=.0001). KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. These two methods did not differ significantly in categorical classification. CONCLUSION: KASI is more accurate or at least as accurate as the existing tool in estimation of functional status. The characteristics such as self-administration, availability of outcome as a continuous variable are expected to make it a convenient, efficacious and useful tool in various clinical researches.
Classification ; Exercise Test ; Heart ; Humans ; Pilot Projects ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: There has been a need for functional status measurement tool with better validity than the existing tools such as New York Heart Association Functional Class. Duke Activity Status Index (DASI) is a representative example of a tool that was developed to enhance the validity of measurement by asking the patients about the ability to perform specific activities and scoring the response. Because such a tool must be culture-sensitive, it is desirable to use 'Koreanized' version of the tool. No Koreanized version of the functional status measurement tool has been developed yet. The objective of this study is to develop a Korean version of DASI. MATERIALS AND METHOD: In the developmental phase, a pilot questionnaire asking the ability to perform specific activity was made with reference to existing tools, such as Specific Activity Scale and DASI. Substitution, correction and addition of items were done through the pilot study. Ninety-nine patients was asked to fill developmental version of questionnaire, then underwent treadmill exercise test. Weight for each items were assigned to optimize the correlation between the calculated index (KASI) and total treadmill exercise time. Criteria for categorical functional classification were determined to maximize the agreement between KASI-estimated functional class (KASIFC) and functional class estimated by exercise time. In the validation phase, final version of questionnaire was tested in independent group of 159 patients. The questionnaire was self-administered. Canadian Cardiovascular Society Functional Class (CCSFC) was estimated by the physician who is in charge of treadmill exercise test. RESULTS: In the validation phase, Spearman correlation coefficient between KASI and treadmill exercise time was 0.62(p=.0001) and between CCSFC and exercise time -0.48(p=.0001). KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. These two methods did not differ significantly in categorical classification. CONCLUSION: KASI is more accurate or at least as accurate as the existing tool in estimation of functional status. The characteristics such as self-administration, availability of outcome as a continuous variable are expected to make it a convenient, efficacious and useful tool in various clinical researches.
Classification ; Exercise Test ; Heart ; Humans ; Pilot Projects ; Surveys and Questionnaires

Hypercalcemia in accelerated phase of chronic myelogenous leukemia (CML) is very rare. Its pathogenesis is considered humoral hypercalcemia of malignancies mediated by parathyroid hormone-related protein (PTHrP). In severe hypercalcemia, calcifications in kidneys, skin, vessels, heart, and stomach may occur. Our two cases were admitted because of severe hypercalcemia in accelerated phase of CML. On Tc-99m methylene diphosphonate (MDP) bone scintigraphies, a marked tracer accumulation was seen in the lung, heart, stomach and kidney. We report increased tracer accumulation of multiple organs on Tc-99m MDP bone scintigraphy in two rare hypercalcemic patients with CML.
Adult ; Bone Diseases/radionuclide imaging* ; Bone Diseases/etiology* ; Calcinosis/radionuclide imaging ; Calcinosis/etiology ; Case Report ; Human ; Hypercalcemia/radionuclide imaging* ; Hypercalcemia/etiology* ; Leukemia, Myeloid, Chronic/metabolism ; Leukemia, Myeloid, Chronic/complications* ; Male ; Middle Age ; Proteins/metabolism ; Technetium/diagnostic use

BACKGROUND: Atherosclerosis is the most important disease that may cause ischemic syndrome in many organs including heart. It is supposed that apoptosis of vascular smooth muscle cells(VSMCs) is closely related to the progression and rupture of atheromatous plaque. Recent studies have documented evidence for elevated level of nitric oxide(NO) within advanced human atheroma and evidence of regression of atheroma by NO. So this study is designed to evaluate whether exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs and which proapoptotic gene(s) is involved in this type of apoptosis. METHODS: Rat VSMCs were cultured and used for experiment at passage 5 through 7. For NO donor, sodium nitroprusside (SNP) and S-nitroso-N-acetylpenicillamine(SNAP) of 0.5, 1, 2, 4mM were exposed to subconfluent VSMCs. The cells were harvested at 6, 12, 24, 48, 72hours after exposure of NO donors. Apoptosis was to be identified by 4, 6-diamidino-2-phenylindole dihydrochloride(DAPI) staining of nuclei and in-situ nick end labeling(TUNEL). The amount of fragmented DNA was analyzed semiquantitatively by diphenylamine(DPA) assay. Immunocytochemical(ICC) staining and western bolt analyses were designed to detect apoptosisrelated gene products, such as Bax-a, Fas and Bcl-2. RESULTS: 1) Decreased mitotic activity was shown after 12 hours exposure of exogenous NO donors, and condensation and margination of chromatin was identified agter 24 hours exposure, by DAPI staining. 2) Percent DNA fragmentation assessed by DPA method was 0,2,9,48,45% at 0,6,12,24,48 hours after exposure of 2mM of NO donors respectively. 3) The expression of Bax-a and Bcl-2 proteins was demonstrated in apoptotic cells by ICC staining. 4) The expression of Bax-a protein in cells under 24 hours exposure of NO donors was elevated by more than 18% of control level on densitometric analysis of western blot. The level of Bcl-2 was suppressed by 26% of control. So, Bax-a/Bcl-2 ratio in cells under exposure of NO donors was elevated to 2.0 from 1.2 of control level. CONCLUSIONS: Exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs, and it is considered that bax-a and bcl-2 genes are involved in this type of apoptosis.
Animals ; Apoptosis* ; Atherosclerosis ; Blotting, Western ; Chromatin ; DNA ; DNA Fragmentation ; Genes, bcl-2 ; Heart ; Humans ; Muscle, Smooth, Vascular* ; Nitric Oxide ; Nitroprusside ; Plaque, Atherosclerotic ; Rats* ; Rupture ; Tissue Donors

BACKGROUND: Platelet plays an important role in the pathogenesis of acute coronary syndrome. Platelet glycoprotein IIb III a is the receptor for fibrinogen, and it plays an important role in the platelet aggregation. It was reported that polymorphism of the platelet glycoprotein III a (PlA1/A2) is related to acute coronary syndrome, especially in young patients. The aims of this study is to evaluate the relationship between platelet glycoprotein III a polymorphism and acute coronary syndrome in Koreans. METHOD: We studied total 208 patients (M: F=131 : 77, mean ages : 57.2+/-9.7). Acute coronary group comprised 110 patients, who underwent coronary angiography with the impression of acute myocardial infarction or unstable angina. Normal group comprised 98 patients who had no significant angiographic lesion. Genomic DNA was extracted from peripheral blood. To determine the frequency of PlA1/A2 genotype, polymerase chain reaction (PCR) was done and the product was restricted with Msp I. 3% gel electrophoresis showed Restriction Fragment Length Polymorphism (RFLP). Clinical profile and risk factor were also reviewed. RESULT: One patient in the acute coronary group is PlA1/A2 heterozygote and all the other are PlA1 homozygote. In normal group, all patients are PlA1 homozygote. The genotypic frequency of PlA1/A2 is consistent with the previous study. CONCLUSION: The genotype frequency of platelet glycoprotein III a gene polymorphism in Koreans is different from that of Caucasian. The allele frequencies of platelet glycoprotein III a is not different between acute coronary syndrome patient and normal control group. Platelet glycoprotein III a polymorphism may not be an hereditary risk factor in Koreans.
Acute Coronary Syndrome* ; Angina, Unstable ; Blood Platelets* ; Coronary Angiography ; DNA ; Electrophoresis ; Fibrinogen ; Gene Frequency ; Genes, vif ; Genotype ; Glycoproteins* ; Heterozygote ; Homozygote ; Humans ; Integrin beta3 ; Myocardial Infarction ; Platelet Aggregation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Risk Factors

BACKGROUND: Platelet plays an important role in the pathogenesis of acute coronary syndrome. Platelet glycoprotein IIb III a is the receptor for fibrinogen, and it plays an important role in the platelet aggregation. It was reported that polymorphism of the platelet glycoprotein III a (PlA1/A2) is related to acute coronary syndrome, especially in young patients. The aims of this study is to evaluate the relationship between platelet glycoprotein III a polymorphism and acute coronary syndrome in Koreans. METHOD: We studied total 208 patients (M: F=131 : 77, mean ages : 57.2+/-9.7). Acute coronary group comprised 110 patients, who underwent coronary angiography with the impression of acute myocardial infarction or unstable angina. Normal group comprised 98 patients who had no significant angiographic lesion. Genomic DNA was extracted from peripheral blood. To determine the frequency of PlA1/A2 genotype, polymerase chain reaction (PCR) was done and the product was restricted with Msp I. 3% gel electrophoresis showed Restriction Fragment Length Polymorphism (RFLP). Clinical profile and risk factor were also reviewed. RESULT: One patient in the acute coronary group is PlA1/A2 heterozygote and all the other are PlA1 homozygote. In normal group, all patients are PlA1 homozygote. The genotypic frequency of PlA1/A2 is consistent with the previous study. CONCLUSION: The genotype frequency of platelet glycoprotein III a gene polymorphism in Koreans is different from that of Caucasian. The allele frequencies of platelet glycoprotein III a is not different between acute coronary syndrome patient and normal control group. Platelet glycoprotein III a polymorphism may not be an hereditary risk factor in Koreans.
Acute Coronary Syndrome* ; Angina, Unstable ; Blood Platelets* ; Coronary Angiography ; DNA ; Electrophoresis ; Fibrinogen ; Gene Frequency ; Genes, vif ; Genotype ; Glycoproteins* ; Heterozygote ; Homozygote ; Humans ; Integrin beta3 ; Myocardial Infarction ; Platelet Aggregation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Risk Factors